RESUMO
Opsoclonus myoclonus and ataxia is a combination of severe neurological signs associated with several pathologic agents and conditions. Only few cases of opsoclonus have been related to West Nile virus infection. We report on a 61-year-old woman and on a 55-year-old man who had history of recent fever, who were hospitalized because of acute severe truncal ataxia, opsoclonus and tremor with minimal myoclonic jerks. A through work-up revealed the presence of both IgM and IgG antibodies against West Nile virus both in the serum and Cerebrospinal Fluid and excluded other causes known to be associated with this combination of neurological signs. The first case was treated with corticosteroids, followed by significant improvement, and the second recovered spontaneously. The acute combination of opsoclonus, severe truncal ataxia and tremor with a history of recent fever requires, during the relevant season and in the relevant geographic area, a search for a recent infection with West Nile virus. Though initially suffering from a devastating sickness, our patients eventually recovered.
Assuntos
Síndrome de Opsoclonia-Mioclonia/complicações , Síndrome de Opsoclonia-Mioclonia/diagnóstico , Febre do Nilo Ocidental/complicações , Febre do Nilo Ocidental/diagnóstico , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Opsoclonia-Mioclonia/tratamento farmacológico , Prognóstico , Febre do Nilo Ocidental/tratamento farmacológicoAssuntos
Hiperplasia do Linfonodo Gigante , Excisão de Linfonodo/métodos , Miastenia Gravis , Neoplasias Pélvicas , Complicações Neoplásicas na Gravidez , Timectomia/métodos , Timoma , Neoplasias do Timo , Adulto , Azatioprina/administração & dosagem , Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/fisiopatologia , Hiperplasia do Linfonodo Gigante/cirurgia , Inibidores da Colinesterase/administração & dosagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Miastenia Gravis/diagnóstico , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/fisiopatologia , Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/fisiopatologia , Neoplasias Pélvicas/cirurgia , Prednisona/administração & dosagem , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/fisiopatologia , Complicações Neoplásicas na Gravidez/cirurgia , Brometo de Piridostigmina/administração & dosagem , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia , Resultado do TratamentoRESUMO
NAP is an eight-amino acid neuroprotective peptide NAPVSIPQ; it is the smallest active element derived from the recently cloned activity-dependent neuroprotective protein (ADNP). NAP readily enters the brain from the blood. It will be important to learn whether NAP, in addition to its neuroprotective activity, also might influence immune-mediated inflammation. Here, we report that: (a) macrophages express ADNP; (b) expression of ADNP in macrophages responds to VIP; and (c) NAP downregulates the key inflammatory cytokines tumor necrosis factor (TNF-alpha), interleukin-16 (IL-16), and IL-12 in macrophages. These findings indicate that ADNP/NAP can play an important role in immune regulation as well as in neuroprotection, which may be mutually related processes.